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Open Access Highly Accessed Open Badges Research article

Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

Alexandre R Marra12*, Michael B Edmond2, Richard P Wenzel2 and Gonzalo ML Bearman2

Author Affiliations

1 Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil

2 Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia, USA

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BMC Infectious Diseases 2007, 7:42  doi:10.1186/1471-2334-7-42

Published: 21 May 2007



Clostridium difficile-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting.


We performed a historical cohort study on 58 adults with a positive C. difficile cytotoxin assay result occurring in intensive care units.


Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score ≥3, gender, concurrent infection, and number of days with diarrhea before a positive C. difficile toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13–1.75) and age (per 1-year increment, OR 1.10; CI95 1.02–1.19).


In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.